The best diet to prevent a heart attack is one that resembles the dietary patterns of peoples who lived on or close to the Mediterranean Sea in the 1960s (not now!). The good news is that the clinical research strongly supports the Mediterranean diet, and there are many changes that we can make in our lives to reduce the risk of heart disease. The bad news is that it is very difficult to change our dietary habits and lifestyle. We need to be patient with ourselves, try new recipes to expand our palates and understand that the cardio-protective effects of the Mediterranean diet go beyond the food. It is the whole lifestyle, including their joie de vivre. Taking a step back in time to enjoy the simple, old-fashioned pleasures might help you prolong your life and reduce your risk of cardiac disease.

The Clinical Research

Support for the Mediterranean diet and lifestyle comes from many studies.

Several studies looking into the French Paradox (low death rates from heart disease despite a high intake of cholesterol and saturated fats) have indicated that the French lifestyle seems to protect the heart.

The Lyon Heart Study, published in Circulation in 2001, showed that patients who had survived a heart attack and followed the Mediterranean diet had a 50–70 percent lower risk of repeat heart events. In this famous study, physiologist Ancel Keys showed that men living in Greece had the lowest rates of death from heart disease.

The Diabetes Prevention Program study, published in the prestigious New England Journal of Medicine, showed that a healthy diet that resulted in a weight loss of only 5–7 percent of body weight, along with 30 minutes of physical activity, could reduce the incidence of diabetes by 58 percent.

A study published in the September 2004 Journal of the American Medical Association (JAMA) recommended the Mediterranean diet for people who have what is called metabolic syndrome (a pre-diabetes and pre-cardiovascular-disease condition).

Metabolic Syndrome

The underlying causes of Metabolic Syndrome are overweight/obesity, physical inactivity and genetic factors. If you have three or more of the components below, you probably have metabolic syndrome.

A body shape that resembles an apple more than a pair (a waist measurement at its widest (not your pant size) of larger than 40 inches for men or 35 inches for women).

Fasting blood triglycerides greater than or equal to 150 mg/dl.

An HDL (good) cholesterol level less than 40 mg/dl for men or less than 50mg/dl.for women

A blood pressure greater than or equal to 130/85.

A fasting glucose greater than or equal to 110mg/dl.

See your doctor to plan an aggressive program to reduce your weight and increase your physical activity.

Within each country there are many dietary differences. Southern French food is not Parisian French food and the same holds true for Italy and most of the other countries that border on the Mediterranean. There are tremendous differences in culture, ethnic backgrounds, religions, economy and native foods that make for delightful and unique cuisines and lifestyles. But among these differing diets and lifestyles there are similarities—factors that protect against cardiovascular disease, which is the leading cause of death for both men and women in the US.

Mediterranean Diet components:

Lots of fruits and vegetables: five or more servings of vegetables, and two or three servings of fruits per day.

Lots of whole grains, beans, nuts and seeds: 1–3 servings of nuts and legumes per day. Liberal amounts of whole grains and whole-grain products. Limit potatoes and refined carbohydrates such as white bread, white rice and pasta (unless you are very physically active).

Lean red meat only once or twice a month in small portions: no more than 12–16 ounces per month.

A little wine (one or two 4–6-ounce glasses per day, usually at meals).

A daily multivitamin and calcium supplement.

Mediterranean Lifestyle components

Fresh, locally grown foods (not processed!)

Regular physical exercise (about 30–40 minutes on most days of the week)

Pure pleasure and joy in eating. A live-to-eat mentality—enjoying each bite!

Moderate portions to maintain a lean body weight

Heavier midday meal, followed by a short nap!

Communal eating in a relaxed way with family and friends—at a table!

Sadly, the dietary patterns and lifestyles of the Mediterranean peoples are changing. They are eating more meat and sweets and adopting more of our American lifestyle. And guess what? Cardiovascular disease, obesity, hypertension, high cholesterol and diabetes rates are rising there. Studies have shown that when various ethnic populations move to our country and modify their traditional diet and lifestyle, they develop risk factors for cardiovascular disease, just like an American!

So pick a country or countries—France? Italy? Greece?—and take a trip in your dreams and in your diet, to protect your family from heart disease!